Provider Demographics
NPI:1023365939
Name:METCHNIKOFF, CHRISTOPHER LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:LEE
Last Name:METCHNIKOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W. CARSON STREET, BOX 400
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90509-2910
Mailing Address - Country:US
Mailing Address - Phone:310-222-2401
Mailing Address - Fax:
Practice Address - Street 1:14445 OLIVE VIEW DR # 2B-182
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-1437
Practice Address - Country:US
Practice Address - Phone:747-210-3205
Practice Address - Fax:747-210-4573
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA129294207R00000X, 207RA0401X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine